N -acetylcysteine is associated with reduction of postconcussive symptoms in elderly patients: A pilot study.

INTRODUCTION: N -acetylcysteine (NAC) may be neuroprotective by minimizing postconcussion symptoms after mild traumatic brain injury (TBI), but limited data exist. This study evaluated the effects of NAC on postconcussion symptoms in elderly patients diagnosed with mild TBI. METHODS: This prospective, quasirandomized, controlled trial enrolled patients 60 years or older who suffered mild TBI. Patients were excluded if cognitive function could not be assessed within 3-hours postinjury. Patients were allocated to receive NAC plus standard care, or standard care alone, based on the trauma center where they presented. The primary study outcome was the severity of concussive symptoms measured using the Rivermeade Postconcussion Symptoms Questionnaire (RPQ). Symptoms were evaluated on days 0, 7, and 30. The RPQ scores were compared both within and between treatment groups. RESULTS: There were 65 patients analyzed (NAC, n = 34; control, n = 31) with an average age of 76 ± 10 years. Baseline demographics and clinical variables were similar. No group differences in head Abbreviated Injury Scale score or Glasgow Coma Scale score were observed. Baseline RPQ scores (6 [0-20] vs. 11 [4-20], p = 0.300) were indistinguishable. The RPQ scores on day 7 (2 [0-8] vs. 10 [3-18], p = 0.004) and 30 (0 [0-4] vs. 4 [0-13], p = 0.021) were significantly lower in the NAC group. Within-group differences were significantly lower in the NAC ( p < 0.001) but not control group ( p = 0.319). CONCLUSION: N -acetylcysteine was associated with significant improvements in concussion symptoms in elderly patients with mild TBI. These results justify further research into using NAC to treat TBI. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Association of acute depressive symptoms and functional connectivity of emotional processing regions following sport-related concussion.

Acute mood disturbance following sport-related concussion is common and is known to adversely affect post-concussion symptoms and recovery. The physiological underpinnings of depressive symptoms following concussion, however, are relatively understudied. We hypothesized that functional connectivity of the emotional processing network would be altered in concussed athletes and associated with the severity of depressive symptoms following concussion. Forty-three concussed collegiate athletes were assessed at approximately one day (N = 34), one week (N = 34), and one month post-concussion (N = 30). Fifty-one healthy contact-sport athletes served as controls and completed a single visit. The Hamilton Rating Scale for Depression (HAM-D) was used to measure depressive symptoms. Resting state fMRI data was collected on a 3 T scanner (TR = 2 s) and functional connectivity was calculated in a meta-analytically derived network of regions associated with emotional processing. Concussed athletes had elevated depressive symptoms across the first month post-concussion relative to control athletes, but showed partial recovery by one month relative to more acute visits (ps < 0.05). Concussed athletes had significantly different connectivity in regions associated with emotional processing at one month post-concussion relative to one day post-concussion (p = 0.002) and relative to controls (p = 0.003), with higher connectivity between default mode and attention regions being common across analyses. Additionally, depressive symptoms in concussed athletes at one day (p = 0.003) and one week post-concussion (p = 7 × 10-8) were inversely correlated with connectivity between attention (e.g., right anterior insula) and default mode regions (e.g., medial prefrontal cortex). Finally, the relationships with HAM-D scores were not driven by a general increase in somatic complaints captured by the HAM-D, but were strongly associated with mood-specific HAM-D items. These results suggest that connectivity of emotional processing regions is associated with acute mood disturbance following sport-related concussion. Increased connectivity between attention and default mode regions may reflect compensatory mechanisms.

Factors associated with completing comprehensive traumatic brain injury evaluation.

This study examined factors associated with Iraq and Afghanistan Veterans following up with the Department of Veterans Affairs (VA) comprehensive traumatic brain injury (TBI) evaluation after a positive first-level VA TBI screen. Participants included 465 Iraq and Afghanistan Veterans at one VA Medical Center and its five affiliated community-based outpatient clinics, with a positive initial TBI screen between April 1, 2007 and June 1, 2010. We found that 75% of Veterans completed the comprehensive TBI evaluation. Women were three times less likely to complete the comprehensive TBI evaluation than men, and those who endorsed post-traumatic stress disorder avoidance symptoms were nearly two times less likely to complete the comprehensive TBI evaluation. In contrast, headaches, Hispanic ethnicity, and the season of the initial TBI screen (summer vs. winter) were positively associated with completing a comprehensive TBI evaluation. A substantial minority of Veterans who screen positive on the VA initial TBI screen fail to present for the comprehensive TBI evaluation. Addressing specific gender-related issues, avoidance, and the timing of referrals in the context of VA polytrauma programs may increase the likelihood that Veterans receive further assessment, education, and early intervention for TBI or other mental health problems to prevent chronic postdeployment disability.